Biller 31 views

Job Overview

  • Salary Offer Commensurate with Experience
  • Experience Level All, Some Experience, Mid-Level
  • Total Years Experience 1-2
  • Education 2-year degree

The Biller-Inpatient/Outpatient is responsible for the accurate and timely preparation and submission of third party billing/claims to governmental or third party payers. Re-submits claims that fail third party edits and submits second level claims. Provides guidance and support to PAO Billing Assistant and answers correspondence. The Biller will represent the department and Strong-Memorial Hospital (SMH) in a professional-manner, protecting confidentiality of patient information at all times.

Responsibilities:

  • Researches and corrects primary payer claims that have failed to process.
    • Using knowledge of payer billing software makes corrections directly in payer system.
    • Identifies non-routine problems for claims requiring correction and decides action for correction by reviewing bill types and interpreting visit notes.
    • Resolves non-routine upfront edits on Emdeon which include but are not limited to modifier requirements or provider enrollment issues. Identifies claims that require further research and determines source of correction and initiates request through PAO supervisors or appropriate clinical department. Tracks pending claims and makes appropriate correction once answer has been received.
    • Notifies the team Operations Supervisor when the amount of edits holding exceeds normal target ranges. Prepares written summary of the issues regarding the edits.
    • Documents all actions thoroughly in visit notes.
  • Submits secondary payer claims.
    • Prepares paper claims for secondary submission using knowledge of secondary payer unique requirements and processes. Provides primary payment information and determines adjustment information and applicable details required for each claim.
    • Determines when a “no-pay” claim request must be submitted to a primary payer in order to obtain a denial sufficient to be sent to the secondary payer. Reviews claim data and modifiers as well as secondary payer and patient requests prior for appropriateness of secondary payer submission.
    • Compares primary payment to the anticipated secondary payment to determine whether or not to follow secondary payer submission process. Using knowledge of payer rules submits secondary bills after confirming that an additional payment is due.
    • Resolves non-routine upfront edits on Emdeon which include but are not limited to modifier requirements or provider enrollment issues. Identifies claims that require further research and determines source of correction and initiates request through PAO supervisors or appropriate clinical department. Tracks pending claims and makes appropriate correction once answer has been received.
    • Documents all actions thoroughly in visit notes.
  • Corrects claim errors returned post-submission.
    • Reviews claims requiring non-routine correction in payer system to determine method of correction.
    • Adjusts claims through manual process to ensure highest level of reimbursement. Determines cause of error to identify appropriate source that can supply applicable missing information (e.g. modifiers, medically unlikely edits). Tracks pending claims and makes appropriate correction once answer has been received.
    • Identifies the correction method needed when additional modification of a claim triggers an additional edit. Finalizes claim submission following resolution.
  • Other duties as assigned:
    • Provides guidance and support to Billing Assistants
    • Manually keys/ enters late charges on 141 bills in Omnipro
    • Answers correspondence

Qualifications:

Requires: Associate’s degree in Accounting and 1 year of related accounting or collection experience; or an equivalent combination of education and experience.

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